Мультимодальный подход для оценки риска развития сердечной недостаточности у пациентов с острым инфарктом миокарда (часть 1). Клинические и лабораторные предикторы

2022 том 6, №2

Н.Л. Цапаева, С.Ф. Золотухина, Е.В. Миронова, И.В. Гайдукевич, В.Л. Родич, Е.В. Бураковская

УО «Белорусский государственный медицинский университет», г. Минск, Республика Беларусь; УЗ «4 городская клиническая больница имени Н.Е. Савченко», г. Минск, Республика Беларусь

По данным российского эпидемиологического исследования ЭПОХА–ХСН (1998–2017 гг.) в течение 20-летнего наблюдения распространенность хронической сердечной недостаточности (ХСН) увеличилась с 6,1 до 8,2%. Основными причинами формирования ХСН остаются артериальная гипертония, ишемическая болезнь сердца, фибрилляция предсердий, сахарный диабет. При этом острый инфаркт миокарда (ОИМ) как причина формирования сердечной недостаточности увеличилась в 3 раза. Медиана времени дожития среди пациентов с ХСН I–II функционального класса (ФК) составляет 8,4 года, пациентов с ХСН III–IV ФК – 3,8 года, что свидетельствует о плохом прогнозе ХСН любого функционального класса. В настоящее время предложен ряд клинических, биохимических, ангиографических, визуализирующих подходов к стратификации риска ХСН после ОИМ, однако только немногие из них используются в рутинной клинической практике. Учитывая нарастающий вклад ХСН в заболеваемость и смертность после ОИМ, необходима ранняя мультимодальная стратификация риска для разработки профилактических стратегий, направленных на предотвращение этого осложнения. В настоящем сообщении представлены современные взгляды на роль клинических факторов риска, биохимических и генетических маркеров ХСН, рассматриваемых как ранние предикторы формирования сердечной недостаточности у пациентов с острым инфарктом миокарда.

ключевые слова: сердечная недостаточность, клинические факторы риска, биомаркеры, генетика, неблагоприятное ремоделирование.

для цитирования: Н.Л. Цапаева, С.Ф. Золотухина, Е.В. Миронова, И.В. Гайдукевич, В.Л. Родич, Е.В. Бураковская. Мультимодальный подход для оценки риска развития сердечной недостаточности у пациентов с острым инфарктом миокарда (Часть 1). Клинические и лабораторные предикторы. Неотложная кардиология и кардиоваскулярные риски, 2022, Т. 6, № 2, С. 1592–1603.

A multimodal approach to assess the risk of heart failure in patients with acute myocardial infarction (part 1). Clinical and laboratory predictors

N. Tsapaeva, S. Zolotuhina, Е. Mironova, I. Gajdukevich, V. Rodich, Е. Burakovskaja

According to the Russian epidemiological study EPOСHA-CHF (1998–2017), during a 20-year follow-up, the prevalence of chronic heart failure (CHF) increased from 6.1 to 8.2%. Arterial hypertension, coronary heart disease, atrial fibrillation, diabetes mellitus remain the main causes of CHF. At the same time, acute myocardial infarction (AMI) as a cause of heart failure increased by 3 times. The median survival time among the patients with CHF I-II functional class (FC) is 8.4 years, and 3.8 years among the patients with CHF III-IV FC, which indicates a poor prognosis of CHF of any functional class. Currently, a number of clinical, biochemical, angiographic, and imaging approaches have been proposed to stratify the risk of CHF after AMI, but only a few of them are used in routine clinical practice. Given the increasing contribution of CHF to morbidity and mortality after myocardial infarction, early multimodal risk stratification is needed to develop preventive strategies aimed at averting this complication. This report presents current ideas about the role of clinical risk factors, biochemical and genetic markers of CHF, considered as early predictors of heart failure in patients with acute myocardial infarction.

keywords: heart failure, clinical risk factors, biomarkers, genetics, adverse remodelling.

for references: N. Tsapaeva, S. Zolotuhina, Е. Mironova, I. Gajdukevich, V. Rodich, Е. Burakovskaja. A Multimodal approach to assess the risk of heart failure in patients with acute myocardial infarction (Part 1). Clinical and laboratory predictors. Neotlozhnaya kardiologiya i kardiovaskulyarnye riski [Emergency cardiology and cardiovascular risks], 2022, vol. 6, no. 2, pp. 1592–1603.

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